doi:10.3969/j.issn.1674-490X.2025.05.008

Abstract

Abstract: Enteral nutrition is the preferred nutritional therapy for critically ill patients, and early enteral nutrition intervention is particularly important during the recovery phase of critical illness. However, due to the complexity of their condition, critically ill patients often experience early enteral nutrition intolerance. Based on this, relevant literatures were reviewed to summarize the contributing factors, assessment methods, and preventive measures of early enteral nutrition intolerance. The aim is to provide a theoretical basis for clinical nursing practice to improve the nutritional status of critically ill patients, promote early recovery of gastrointestinal function, reduce mortality, and shorten hospital stays.

Key words: critically ill patients, early enteral nutrition, tolerance

CLC Number:

R472.5

References

[1] MCCLAVE S A, CODNER P, PATEL J, et al. Should we aim for full enteral feeding in the first week of critical illness?[J]. Nutr Clin Pract, 2016, 31(4): 425-431. DOI: 10.1177/0884533616653809.
[2] LEW C C H, YANDELL R, FRASER R J L, et al. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review formula: see text[J]. JPEN J Parenter Enteral Nutr, 2017, 41(5): 744-758. DOI: 10.1177/0148607115625638.
[3] BARHORST S, PRIOR R M, KANTER D. Implementation of a best-practice guideline: early enteral nutrition in a neuroscience intensive care unit[J]. JPEN J Parenter Enteral Nutr, 2023, 47(1): 87-91. DOI: 10.1002/jpen.2411.
[4] CHOW R, BRUERA E, CHIU L, et al. Enteral and parenteral nutrition in cancer patients: a systematic review and meta-analysis[J]. Ann Palliat Med, 2016, 5(1): 30-41. DOI: 10.3978/j.issn.2224-5820.2016.01.01.
[5] PFAB F, WINHARD M, NOWAK-MACHEN M, et al. Acupuncture in critically ill patients improves delayed gastric emptying: a randomized controlled trial[J]. Anesth Analg, 2011, 112(1): 150-155. DOI: 10.1213/ANE.0b013e3181fdfac8.
[6] TIAN F, HEIGHES P T, ALLINGSTRUP M J, et al. Early enteral nutrition provided within 24 hours of ICU admission: a meta-analysis of randomized controlled trials[J]. Crit Care Med, 2018, 46(7): 1049-1056. DOI: 10.1097/CCM.0000000000003152.
[7] WANG J J, YU K, ZENG Y P. Early enteral nutrition intervention promotes multiple functional recovery in patients with traumatic intracerebral hemorrhage: a prospective randomized controlled study[J]. Clin Neurol Neurosurg, 2023, 234: 108010. DOI: 10.1016/j.clineuro.2023.108010.
[8] BLASER A R, STARKOPF J, ALHAZZANI W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines[J]. Intensive Care Med, 2017, 43(3): 380-398. DOI: 10.1007/s00134-016-4665-0.
[9] MCCLAVE S A, TAYLOR B E, MARTINDALE R G, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine(SCCM)and American society for parenteral and enteral nutrition(A.S.P.E.N.)[J]. JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211. DOI: 10.1177/0148607115621863.
[10] TAYLOR B E, MCCLAVE S A, MARTINDALE R G, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of critical care medicine(SCCM)and american society for parenteral and enteral nutrition(A.S.P.E.N.)[J]. Crit Care Med, 2016, 44(2): 390-438. DOI: 10.1097/CCM.0000000000001525.
[11] MCCLAVE S A, GUALDONI J, NAGENGAST A, et al. Gastrointestinal dysfunction and feeding intolerance in critical illness: do we need an objective scoring system?[J]. Curr Gastroenterol Rep, 2020, 22(1): 1. DOI: 10.1007/s11894-019-0736-z.
[12] GUNGABISSOON U, HACQUOIL K, BAINS C, et al. Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness[J]. JPEN J Parenter Enteral Nutr, 2015, 39(4): 441-448. DOI: 10.1177/0148607114526450.
[13] HEYLAND D K, ORTIZ A, STOPPE C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database[J]. Crit Care Med, 2021, 49(1): 49-59. DOI: 10.1097/CCM.0000000000004712.
[14] WANG L Z, XIANG Y, LI Q, et al. Risk factors of enternal nutrition intolerance in septic patients: a case-control study[J]. Curr Med Sci, 2024, 44(2): 328-332. DOI: 10.1007/s11596-024-2849-3.
[15] 苏小平,徐静娟,赵亚东,等.危重患者早期肠内营养喂养不耐受风险预测模型的构建[J].护理学报, 2022, 29(17): 47-51. DOI: 10.16460/j.issn1008-9969.2022.17.047.
[16] TAN M, ZHU J C, YIN H H. Enteral nutrition in patients with severe traumatic brain injury: reasons for intolerance and medical management[J]. Br J Neurosurg, 2011, 25(1): 2-8. DOI: 10.3109/02688697.2010.522745.
[17] YU K R, GUO N, ZHANG D D, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study[J]. Chin Med J(Engl), 2022, 135(15): 1814-1820. DOI: 10.1097/CM9.0000000000001974.
[18] YAHYAPOOR F, DEHNAVI Z, ASKARI G, et al. The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: a cross-sectional study[J]. J Res Med Sci, 2021, 26: 60. DOI: 10.4103/jrms.JRMS_689_20.
[19] RAFIEI M R, AGHADAVOUDI O, SHEKARCHI B, et al. Can selection of mechanical ventilation mode prevent increased intra-abdominal pressure in patients admitted to the intensive care unit?[J]. Int J Prev Med, 2013, 4(5): 552-556.
[20] 曾佳琪,张博,苏红辉.口腔颌面部恶性肿瘤患者肠内营养喂养不耐受状况及影响因素[J]. 南方医科大学学报, 2021, 41(7): 1114-1118. DOI: 10.12122/j.issn.1673-4254.2021.07.22.
[21] 马晶晶,王昌,季文莹,等.对短肽型肠内营养制剂不耐受的克罗恩病活动期患者药学监护1例[J].临床合理用药, 2024, 17(1): 169-172. DOI: 10.15887/j.cnki.13-1389/r.2024.01.046.
[22] 韩晓丽,薛梅,高云,等.不同类型肠内营养制剂对重症脑卒中病人营养状况的影响[J].肠外与肠内营养, 2015, 22(6): 329-331. DOI: 10.16151/j.1007-810x.2015.06.003.
[23] 梅宛平,洪雅华,李斯,等.肠内营养液加温输注对危重症病人胃肠道并发症影响的Meta分析[J].循证护理, 2023, 9(1): 16-22. DOI: 10.12012/j.issn.2095-8668.2023.01.003.
[24] 张晋,张延英,尤华琴.重症监护室老年病人肠内营养相关性腹泻的影响因素[J].护理研究, 2022, 36(14): 2624-2626. DOI: 10.12102./j.issn.1009-6493.2022.14.037.
[25] 吴琪,朱保锋,陈建荣.床旁超声监测胃残余量在指导危重症患者肠内营养治疗中的研究进展[J].临床急诊杂志, 2023, 24(1): 46-50. DOI: 10.13201/j.issn.1009-5918.2023.01.009.
[26] SHARMA V, GUDIVADA D, GUERET R, et al. Ultrasound-assessed gastric antral area correlates with aspirated tube feed volume in enterally fed critically ill patients[J]. Nutr Clin Pract, 2017, 32(2): 206-211. DOI: 10.1177/0884533616681530.
[27] 徐东平,钱正仙,全殷殷,等.床边超声监测胃残余量在重症患者早期肠内营养管理中的应用研究[J].护理与康复, 2021, 20(3): 7-11. DOI: 10.3969/j.issn.1671-9875.2021.03.002.
[28] 刘宁,李琦,孙伟生.床旁超声胃残余量监测在ICU重症脑卒中患者肠内营养实施中的应用研究[J].现代诊断与治疗, 2023, 34(9): 1355-1357.
[29] KAYDU A, GOKCEK E. Preoperative assessment of ultrasonographic measurement of antral area for gastric content[J]. Med Sci Monit, 2018, 24: 5542-5548. DOI: 10.12659/MSM.908520.
[30] KIRKPATRICK A W, ROBERTS D J, DE WAELE J, et al. Intra-abdominal hypertension and the abdominal compartment syndrome: updated consensus definitions and clinical practice guidelines from the World Society of the Abdominal Compartment Syndrome[J]. Intensive Care Med, 2013, 39(7): 1190-1206. DOI: 10.1007/s00134-013-2906-z.
[31] KHOT Z, MURPHY P B, SELA N, et al. Incidence of intra-abdominal hypertension and abdominal compartment syndrome: a systematic review[J]. J Intensive Care Med, 2021, 36(2): 197-202. DOI: 10.1177/0885066619892225.
[32] 叶向红,彭南海,江方正,等.重症急性胰腺炎合并腹腔高压患者早期肠内营养耐受性的管理[J].中华护理杂志, 2016, 51(12): 1439-1442. DOI: 10.3761/j.issn.0254-1769.2016.12.006.
[33] 赵媛媛,杜立强,刘淑红,等.腹内压监测在ICU患者早期肠内营养中应用研究[J].创伤与急危重病医学, 2020, 8(2): 88-90. DOI: 10.16048/j.issn.2095-5561.2020.02.07.
[34] 宋墨君,段俊芳,张艳,等.腹内压监测在ICU病人早期肠内营养中的应用效果[J].护理研究, 2023, 37(6): 1064-1067. DOI: 10.12102/j.issn.1009-6493.2023.06.024.
[35] 邢柏,曾琦,谭世峰,等.腹内压对危重患者早期肠内营养耐受性的评估价值[J].海南医学, 2014, 25(5): 642-644. DOI: 10.3969/j.issn.1003-6350.2014.05.0251.
[36] 邓宝群,代高英.腹内压对重症急性胰腺炎病人早期肠内营养喂养不耐受的预测价值[J].护理研究, 2020, 34(8): 1378-1382. DOI: 10.12102/j.issn.1009-6493.2020.08.014.
[37] LIAO C H, CHENG C T, CHEN C C, et al. An ingestible electronics for continuous and real-time intraabdominal pressure monitoring[J]. J Pers Med, 2020, 11(1): 12. DOI: 10.3390/jpm11010012.
[38] LI Q, ZHANG Z H, XIE B, et al. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: a before and after study[J]. PLoS One, 2017, 12(8): e0182393. DOI: 10.1371/journal.pone.0182393.
[39] SUN J K, NIE S, CHEN Y M, et al. Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis[J]. World J Gastroenterol, 2021, 27(29): 4900-4912. DOI: 10.3748/wjg.v27.i29.4900.
[40] YUE H Y, PENG W, ZENG J, et al. Efficacy of permissive underfeeding for critically ill patients: an updated systematic review and trial sequential meta-analysis[J]. J Intensive Care, 2024, 12(1): 4. DOI: 10.1186/s40560-024-00717-3.
[41] 广东省药学会.肠外肠内营养临床药学实践共识(2022年版)[J].今日药学, 2023, 33(6):414-421. DOI: 10.12048/j.issn.1674-229X.2023.06.002.
[42] 卢丽华,蔡博瑜,朱小玲.神经内科危重病人肠内营养不同输注速度对胃潴留的影响[J].肠外与肠内营养, 2020, 27(6): 368-371. DOI: 10.16151/j.1007-810x.2020.06.011.
[43] LEE H Y, LEE J K, KIM H J, et al. Continuous versus intermittent enteral tube feeding for critically ill patients: a prospective, randomized controlled trial[J]. Nutrients, 2022, 14(3): 664. DOI: 10.3390/nu14030664.
[44] LI Y L, YANG J, SUN S X, et al. Effects of intermittent feeding versus continuous feeding on enteral nutrition tolerance in critically ill patients: a protocol for systematic review and meta-analysis[J]. Medicine(Baltimore), 2020, 99(50): e23528. DOI: 10.1097/MD.0000000000023528.
[45] 中华医学会肠外肠内营养学分会.中国成人患者肠外肠内营养临床应用指南(2023版)[J].中华医学杂志, 2023, 103(13): 946-974. DOI: 10.3760/cma.j.cn112137-20221116-02407.
[46] ARVANITAKIS M, OCKENGA J, BEZMAREVIC M, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis[J]. Clin Nutr, 2020, 39(3): 612-631. DOI: 10.1016/j.clnu.2020.01.004.
[47] JABŁON'SKA B, MROWIEC S. Nutritional support in patients with severe acute pancreatitis-current standards[J]. Nutrients, 2021, 13(5): 1498. DOI: 10.3390/nu13051498.
[48] RAMANATHAN M, AADAM A A. Nutrition management in acute pancreatitis[J]. Nutr Clin Pract, 2019, 34(Suppl 1): S7-S12. DOI: 10.1002/ncp.10386.
[49] BLASER A R, REGLI A, DE KEULENAER B, et al. Incidence, risk factors, and outcomes of intra-abdominal hypertension in critically ill patients-a prospective multicenter study(IROI study)[J]. Crit Care Med, 2019, 47(4): 535-542. DOI: 10.1097/CCM.0000000000003623.
[50] 邱双双,刘卉芳,艾叶青,等.腹内压分级管理对重症病人早期肠内营养达标率的影响[J].肠外与肠内营养, 2022, 29(3): 162-166, 171. DOI: 10.16151/j.1007-810x.2022.03.007.
[51] QIN L, ZHANG X X, JIN X, et al. The effect of acupuncture on enteral nutrition and gastrointestinal dynamics in patients who have suffered a severe stroke[J]. Curr Neurovasc Res, 2022, 19(3): 275-281. DOI: 10.2174/1567202619666220 822123023.
[52] ZHANG X, WANG L, CHEN D C. Effect of rhubarb on gastrointestinal dysfunction in critically ill patients: a retrospective study based on propensity score matching[J]. Chin Med J(Engl), 2018, 131(10): 1142-1150. DOI: 10.4103/0366-6999.231523.
[53] 刘盛冬.资生丸汤剂改善危重症患者早期肠内营养喂养不耐受的效果评价[J].人人健康, 2019(10): 122.

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